• What you will need to complete this form:

  • Please have the following information available before you begin:

    • Details of any relevant membership or licence number
    • Annual turnover
    • Annual wageroll for employees if applicable. 
    • Name of your current insurer
    • Current insurance policy expiry date
    • Details of any previous claims, including: date of claim, nature of claim, amount paid

    Please note, we cannot quote if you are already insured via SEIB. 

  • Duty of Disclosure of Material Facts (Duty of Fair Presentation)

    A material fact is an important fact about you or your circumstances. Fair presentation means that you must have disclosed all material facts, matters and circumstances which you know, which could influence an insurer's or underwriter's decision to accept your insurance. This also applies to facts that you ought to know. You must disclose sufficient information to make the insurers aware that they need to make further enquiries. They can then choose to accept or decline your insurance. If they accept, they may apply certain terms. The duty of fair presentation is a significant obligation placed upon you under the contract of insurance. If you fail to meet this obligation, insurers can take various actions in accordance with the Insurance Act 2015.
  • Is the risk address the same as the correspondence address?*
  • Format: 00000 000000.

  • Date of birth*
     / /
  • Is a joint policy required?*
  • Date of birth*
     / /
  • Are any other activities carried out?*
  • Are any other businesses run from the premises?*
  • Do you own or lease the premises?*
  • If lease, do you have a written contract in place with the landlord to stipulate who is responsible for fences/hedges etc?
  • What date should your policy commence? *
     / /
  • If cover is for a single event, please state the date of the event:
     - -
  • Are the ponies you will be using all owned by you?*
  • Will there be a ridden element?*
  • Where will the parties be taking place?*
  • Will the parties be taking place within a secure area?*
  • Will all children's parent/guardian be present at all times?*
  • Do you hold a valid licence from your local authority?*
  • Are you aware of your obligations under the Health & Safety Act 1974? (see www.hse.gov.uk)*
  • Do you have a current DBS check?*
  • Do you have an accident report book?*
  • If yes, is it updated if an accident occurs?
  • Are your electrical installations checked and maintained in accordance with current Health & Safety regulations?*
  • Do you have a written Health & Safety with risk assessments in place?*
  • Are your risk assessments reviewed regularly?*
  • Have full risk assessments of the ponies been carried out, with written records kept?*
  • Have any of the ponies ever shown any signs of abnormal behaviour? (for example but not limited to: kicking, biting, bucking, bolting etc.)*
  • Do you have any employees (paid or voluntary)?*

  • Please note you are legally required to arrange Employers' Liability for paid employees and for paid self-employed persons working under your direction.   
  • Do you have a written staff induction/training records?
  • If you have employees, will Personal Protective Equipment (PPE) be provided?
  • Will the PPE be checked regularly with written records of the checks kept?
  • Do you ensure you have sufficient qualified first aid staff available at all times?*
  • Have you communicated all risk assessments to your staff?
  • Has any insurer in respect of any of the risks to which this proposal refers, declined to insure you, cancelled or refused to renew your insurance or imposed special terms?*
  • Have there been any losses suffered, or events occurred which might have resulted in a claim, whether or not claimed for, during the last five years, in respect of any of the activities for which cover is required?*
  • Have you or any of your officers, business partners or directors, ever been convicted of any criminal offence other than a driving offence or have any non-motoring prosecutions pending?  You only need tell us about any convictions that are unspent under the Rehabilitation of Offenders Act 1974.*
  • Have you or any of your officers, business partners or directors, ever been declared bankrupt or insolvent?*
  • Have you or any of your officers, business partners or directors, ever been investigated or convicted under the Fraud Act 2006, or equivalent legislation?*
  • How would you prefer to be contacted by Cliverton?*
  • Would you like to receive news and updates from Cliverton?*

  • Heading

    Not making a fair presentation of the risk, or not advising us of any errors in the information provided may result in a breach of the fair presentation of risk. Depending on the nature of the breach and what would have happened had the information been accurate, the insurer may choose to: 1. Declare your policy void (treating your policy as it had never existed) 2. Change the terms of your policy. 3. Refuse to deal with all or part of any claim or reduce the amount of any claim payment. 4. Cancel your policy. If any of the information within the documents provided is incorrect, you must advise us. We reserve the right to change the terms and conditions, premium or withdraw this quotation.
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